Individual
STEPHEN ROBERT SOUTHWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
499 GLOSTER CREEK VLG STE G1, TUPELO, MS 38801-4751
(662) 377-2663
(662) 377-6706
Mailing address
499 GLOSTER CREEK VLG STE G1, TUPELO, MS 38801-4751
(662) 377-2663
(662) 377-6706
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
16972
MS
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
16972
MS
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
16972
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123102
—
MS
Enumeration date
01/27/2006
Last updated
01/26/2023
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